Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | R-11347 | IA |
Y | 2080P0203X | Pediatric Critical Care Doctor | 01085605A | IN |
NPI | 1043705999 |
---|---|
Provider Name | Matthew Aaron Solomon |
First Address | Indianapolis, IN 46202-5109 |
Second Address | Indianapolis, IN 46202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2018 |
Last Update Date | 30/07/2021 |